Lima Rodrigo Moreira E, Navarro Lais Helena Camacho, Nakamura Giane, Solanki Daneshvari R, Castiglia Yara Marcondes Machado, Vianna Pedro Tadeu Galvão, Ganem Eliana Marisa
Department of Anesthesiology, Botucatu Medical School, Universidade Estadual Paulista (UNESP), Botucatu, SP, Brazi.
Anesthesiology, AC Camargo Cancer Hospital, São Paulo, SP, Brazil.
Clinics (Sao Paulo). 2014 Jun;69(6):378-83. doi: 10.6061/clinics/2014(06)02.
Pneumoperitoneum during laparoscopy results in transient oliguria and decreased glomerular filtration and renal blood flow. The presence of oliguria and elevated serum creatinine is suggestive of acute renal injury. Serum cystatin C has been described as a new marker for the detection of this type of injury. In this study, our aim was to compare the glomerular filtration rate estimated using cystatin C levels with the rate estimated using serum creatinine in patients with normal renal function who were undergoing laparoscopic surgery.
In total, 41 patients undergoing laparoscopic cholecystectomy or hiatoplasty were recruited for the study. Blood samples were collected at three time intervals: first, before intubation (T1); second, 30 minutes after the establishment of pneumoperitoneum (T2); and third, 30 minutes after deflation of the pneumoperitoneum (T3). These blood samples were then analyzed for serum cystatin C, creatinine, and vasopressin. The Larsson formula was used to calculate the glomerular filtration rate based on the serum cystatin C levels, and the Cockcroft-Gault formula was used to calculate the glomerular filtration rate according to the serum creatinine levels.
Serum cystatin C levels increased during the study (T1 = T2<T3; p<0.05), whereas serum creatinine levels decreased (T1 = T2>T3; p<0.05). The calculated eGlomerular filtration rate-Larsson decreased, whereas the eGlomerular filtration rate-Cockcroft-Gault increased. There was no correlation between cystatin C and serum creatinine. Additionally, Pearson's analysis showed a better correlation between serum cystatin C and the eGlomerular filtration rate than between serum creatinine and the eGlomerular filtration rate.
This study demonstrates that serum cystatin C is a more sensitive indicator of changes in the glomerular filtration rate than serum creatinine is in patients with normal renal function who are undergoing laparoscopic procedures.
腹腔镜手术期间的气腹会导致短暂性少尿、肾小球滤过率及肾血流量降低。少尿和血清肌酐升高提示急性肾损伤。血清胱抑素C已被描述为检测此类损伤的一种新标志物。在本研究中，我们的目的是比较在接受腹腔镜手术的肾功能正常患者中，使用胱抑素C水平估算的肾小球滤过率与使用血清肌酐估算的肾小球滤过率。
总共招募了41例接受腹腔镜胆囊切除术或贲门成形术的患者参与本研究。在三个时间点采集血样：第一，插管前（T1）；第二，气腹建立后30分钟（T2）；第三，气腹放气后30分钟（T3）。然后对这些血样进行血清胱抑素C、肌酐和血管加压素分析。基于血清胱抑素C水平，使用拉尔森公式计算肾小球滤过率；根据血清肌酐水平，使用考克洛夫特-高尔特公式计算肾小球滤过率。
研究期间血清胱抑素C水平升高（T1 = T2 < T3；p < 0.05），而血清肌酐水平降低（T1 = T2 > T3；p < 0.05）。计算得出的估算肾小球滤过率-拉尔森降低，而估算肾小球滤过率-考克洛夫特-高尔特升高。胱抑素C与血清肌酐之间无相关性。此外，Pearson分析显示，血清胱抑素C与估算肾小球滤过率之间的相关性优于血清肌酐与估算肾小球滤过率之间的相关性。
本研究表明，对于接受腹腔镜手术的肾功能正常患者，血清胱抑素C是比血清肌酐更敏感的肾小球滤过率变化指标。
